Rebecca H. Johnson

BACKGROUND: Although rising incidence rates of testicular germ cell tumors have been well documented in white men, relatively little is known about rates in men of Hispanic origin. In the current study, the authors compared germ cell tumor trends between men of Hispanic and non‐Hispanic origin as a function of age at diagnosis.METHODS: Trends in testicular germ cell tumor incidence among white men were analyzed according to Hispanic ethnicity in 2 data sets of the National Cancer Institute's Surveillance, Epidemiology, and End Results Program, spanning from 1992 to 2010 and from 2000 to 2010 and sampling 15% and 28% of the United States population, respectively. Rates were age‐adjusted to the year 2000 US standard population.RESULTS: Between 1992 and 2010, the annual incidence of testicular germ cell tumors among Hispanic whites ages 15 to 39 years increased 58%, from 7.18 cases per 100,000 in 1992 to 11.34 cases per 100,000 by 2010 (P−9). Their incidence rates increased in metropolitan areas for both seminoma and nonseminoma subtypes and for all stages at diagnosis. During the same 19‐year interval, incidence among non‐Hispanic white young adults increased 7%, from 12.41 to 13.22 per 100,000. During the 2000 to 2010 interval, no significant trends were observed in incidence among non‐Hispanic whites.CONCLUSIONS: There has been a recent substantial increase in testicular germ cell tumor incidence among Hispanic adolescents and young adults in the United States. Similar trends were not observed in non‐Hispanic whites. Cancer 2014;120:2728–2734. © 2014 American Cancer Society.

Within the past decade, the discipline of adolescent and young adult (AYA) oncology has taken root in the United States. It arose from the observation that survival improvements for 15–39-year-olds have lagged behind those of both children and older adults. Rapid progress in this new area has resulted from energetic work by researchers, clinicians, and non-profit organizations focusing on AYA-aged cancer patients and survivors. The term “AYA” is now well recognized within both pediatric and medical oncology, and AYA-specific aims are increasingly included in clinical trials and also basic and translational oncology research. The AYA oncology movement in the United States was spearheaded by the LIVESTRONG Young Adult Alliance (the Alliance), a coalition of AYA-focused non-profit organizations and academic institutions that has recently transitioned into a successor organization—Critical Mass: The Young Adult Cancer Alliance, composed of individual AYAO professionals. The work of groups such as the Alliance/Critical Mass and key collaborators—including the National Cancer Institute, National Comprehensive Cancer Network, Children's Oncology Group, and advocacy organizations—provides a useful platform for the discussion of progress in AYA oncology in the United States, including advances in (1) research and tool development; (2) public and professional education; (3) advocacy and patient support; (4) awareness; and (5) service delivery. AYA oncology programs are now burgeoning dramatically throughout the United States, and many well-established U.S. programs share distinctive features in clinical programming. The United States is now entering an era of larger-scale coordinated efforts in research, advocacy, and clinical care for AYAs with cancer.

In Reply: Drs Hou and Huo suggest that we should correct for missing data on receptor status in the SEER database. Using the method¹ cited by Hou and Huo, we calculated that for 25- to 39-year-old women diagnosed with distant stage breast cancer during 1992-2009, the APC after correcting for missing values was 3.85 (95% CI, 1.61 to 6.15; P = .002) for ER+PR+ disease and 3.32 (95% CI, 0.81 to 5.90; P = .01) for ER+PR− disease. The APCs for ER−PR+ and ER−PR− were −6.24 (95% CI, −10.53 to −1.74; P = .01) and 2.01 (95% CI, 0.44 to 3.60; P = .02), respectively. Thus, we again find that the incidence of ER+PR+, ER+PR−, and ER−PR− disease in young women is increasing. The ER−PR+ receptor status was initially nonsignificant but decreased with significance after the correction. We agree that divergent trends exist between the different receptor subtypes, but ER−PR− disease is increasing as are both subtypes of ER+ disease.

In the United States, breast cancer is the most common malignant tumor in adolescent and young adult women 15 to 39 years of age, accounting for 14% of all cancer in men and women in the age group.¹ The individual average risk of a woman developing breast cancer in the United States was 1 in 173 by the age of 40 years when assessed in 2008.² Young women with breast cancer tend to experience more aggressive disease than older women and have lower survival rates.^2,3 Given the effect of the disease in young people and a clinical impression that more young women are being diagnosed with advanced disease, we reviewed the national trends in breast cancer incidence in the United States.

Most adolescents and young adults (AYAs) with cancer will survive their disease, and fertility issues are a major concern for this population. The ASCO and new NCCN Clinical Practice Guidelines in Oncology for Adolescent and Young Adult Oncology recommend that oncologists offer the option of fertility preservation to all postpubertal AYAs before the start of potentially gonadotoxic chemotherapy or radiotherapy, providing that the patient does not require emergent start of therapy. Despite the published practice guidelines, many AYAs diagnosed with cancer are still not offered fertility preservation, with oncologists citing lack of time, lack of knowledge, and discomfort in discussing fertility and sexuality with AYAs as reasons. Developing a systematic and coordinated multidisciplinary strategy for fertility preservation referrals within a practice site may streamline the referral process, off-loading some tasks from the oncologist and potentially increasing patient satisfaction, provider satisfaction, and compliance with the guidelines. Most adolescents and young adults (AYAs) with cancer will survive their disease, and fertility issues are a major concern for this population. The ASCO and new NCCN Clinical Practice Guidelines in Oncology for Adolescent and Young Adult Oncology recommend that oncologists offer the option of fertility preservation to all postpubertal AYAs before the start of potentially gonadotoxic chemotherapy or radiotherapy, providing that the patient does not require emergent start of therapy. Despite the published practice guidelines, many AYAs diagnosed with cancer are still not offered fertility preservation, with oncologists citing lack of time, lack of knowledge, and discomfort in discussing fertility and sexuality with AYAs as reasons. Developing a systematic and coordinated multidisciplinary strategy for fertility preservation referrals within a practice site may streamline the referral process, off-loading some tasks from the oncologist and potentially increasing patient satisfaction, provider satisfaction, and compliance with the guidelines.